vein thrombosis

Types of Spinal Cord Injury (SCI)

Typical complications of SCI include:
Autonomic Dysreflexia (AD)
Orthostatic Hypotension (OH)
Spinal Shock
Spasticity and Hypertonia
Contracture
Pain
Deep Vein Thrombosis (DVT)
Heterotopic Ossification
Osteoporosis and Risk of Fracture
Pressure Sores
Impaired Temperature Control
Pulmonary Impairment
Bladder, Bowel and Sexual Impairments

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I want to talk about Burnie Burns

I want to talk about how much Burnie Burns loves his employees. I want to talk about how proud he is of his people, and how much respect he has for them. And I also want to talk about how protective he is of them.

I want to talk about how he was worried over Jack having Deep Vein Thrombosis so he called him to check on him a lot.

I want to talk about how he thought Gavin was sad, so he sent him a very nice text about how ‘a home is where people love you’

I want to talk about how he was so worried about there being shotgun shells around Millie, thAT HE BROKE INTO THE RAMSEY’S HOUSE AT 4 IN THE MORNING TO GET THEM

Banning abortion means prioritizing a cluster of cells over a grown human being, or as the case may be, a pregnant child as young as 10 or 11.

Banning abortion means forcing women to be mothers regardless of their position in life without ever forcing men to be fathers; without even making sure that men pay child support from wherever they choose to run off to.

Banning abortion means forcing those with female reproductive systems to suffer the risks of ectopic pregnancies, pre-eclampsia, HELLP syndrome, placenta praevia, placenta accreta, unforeseen hemorrhages, deep vein thrombosis, pulmonary embolism, amniotic fluid embolism, and sepsis– risks that include everything from emergency hysterectomy to death.

Banning abortion means condoning the consequence of more girls and women dying from illegal and self-induced abortions, and more newborns left on doorsteps, and more newborns left in cardboard boxes and garbage cans and bodies of water, many of whom will die.

Banning abortion means cornering rape victims into maintaining long-term contact with their rapists and experiencing the powerlessness of sharing their children with people they know to be unsafe, or to experience the trauma of giving up their babies for adoption.

Banning abortion means requiring once joyful mothers-to-be to carry nonviable or dead fetuses– forcing devastated couples with the nursery room already painted– to suffer through a gruesome late miscarriage, stillbirth, or the torture of knowing their child will be born only to suffer horrifically and die within minutes, hours, or days (whereas the parents of already born and terminally ill children have the choice to transition their little one to hospice care or end life support).

I understand and respect why some women (as well as transgender or nonbinary uterus owners) would not feel comfortable choosing abortion for themselves, and at the same time I truly believe we must allow all owners of uteruses autonomy over their bodies. We cannot claim to respect bodily autonomy of all people equally if even a non-sentient deceased body’s organs cannot be donated to save many lives without the person having agreed to it while alive, yet a living adult can be forced to submit to a nine-month saga right in the middle of their internal organs that totally transforms their body and ends in either the extremely painful and potentially injurious event of childbirth or very invasive C-section surgery, not to mention a baby they must now make decisions for. Outlawing abortion is not about saving lives– we know already that outlawing abortion results in people (mothers as well as children) needlessly suffering and dying. Outlawing abortion is about devaluing women; controlling women; dismissing that a woman is qualified to make choices regarding her side of the reproductive process.

have you been sitting down for longer than 30 minutes? this is your reminder to STAND UP AND STRETCH YOUR LEGS for ten seconds before you sit back down

My mom nearly died from a deep-vein thrombosis (blood clot) in her leg, she got it from sitting at her computer and working for too long without getting up. yes, even young people can get DVTs too

so stand up and get your blood moving just a little, shake out your legs, and THEN sit back down

do this every 30 minutes please please keep your veins clotless

anonymous asked:

Can you have a heart attack while in a coma? What would be some of the reasons for that?

Hey there nonny! Heart attacks and comas are not mutually exclusive, so yes, your comatose character can have a heart attack on top of whatever troubles made them comatose. 

Heart attacks in the medical definition (myocardial infarctions) happen because the character has some plaque build up in one of the arteries that feeds the heart (the coronary arteries) that then completely occludes, starving the character of blood in that part of the heart. This can occur without the character being awake. 

Unfortunately, because the character is unconscious, they won’t be able to report the chest pain or shortness of  breath – they’ll likely be intubated – and so it will take doctors a while to figure out what’s going on. An EKG takes a while to show an MI, especially if the MI doesn’t affect the EKG leads that show up on a monitor. (Basically, damage to the inferior wall of the heart is what shows up in leads II and III, the typical “monitoring leads.” Damage to other areas won’t be so obvious.) 

They may not even realize the character is having an MI until the patient craps out completely and dies from their infarct. 

There are other, more connected events that might kill a character in a coma. One is a worsening of whatever caused the coma – usually a brain injury of some sort. Another is a pulmonary embolism. Bodies don’t like to be totally still; they’ll form clots in the deep veins of the leg (Deep Vein Thrombosis, or DVT). That DVT can break off and go to the lungs, and block the blood vessels that feed the lung, called a PE (pulmonary embolism). This is a very common cause of death in patients admitted to the hospital and especially in the ICU. 

Hope this helped!! 

xoxo, Aunt Scripty

(Samantha Keel)

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anonymous asked:

Re the Swedish Maze complaining about people not wanting to sit ALL DAY: Sitting day after day for 6+ hours has given me leg and hip pain. My spine is compressed, I've gained weight. I'm at a higher risk of deep vein thrombosis, which can cause a pulmonary embolism and kill me. Standing all day isn't healthy or enjoyable. Neither is sitting all day. Let the customer get their fucking standing desk. Fuck your boss for not letting you sit but don't complain about others looking after themselves.

alphabet soup: disease edition

Here are a few commonly used medical abbreviations:

AAA - abdominal aortic aneurysm
ACS - acute coronary syndrome
ADHD - attention-deficit/hyperactivity disorder
AIDS - acquired immunodeficiency syndrome
AKI - acute kidney injury
ALS - amyotrophic lateral sclerosis aka Lou Gehrig’s disease
ARDS - acute respiratory distress syndrome
ASD - atrial septal defect
AVM - arteriovenous malformation
BPH - benign prostatic hyperplasia, now known as LUTS
BV - bacterial vaginosis
CAD (s/p PCI/CABG) - coronary artery disease (status post percutaneous coronary intervention/coronary artery bypass grafting)
CHF - congestive heart failure
CKDI-IV - chronic kidney disease (stage I-IV)
COPD (on HOT) - chronic obstructive pulmonary disease (on home oxygen therapy)
CVA - cerebrovascular accident aka stroke
DDD - degenerative disc disease
DJD - degenerative joint disease
DLD - dyslipidemia aka HLD
DMD - Duchenne Muscular Dystrophy
DMI aka IDDM - Diabetes mellitus Type I aka Insulin-Dependent Diabetes mellitus, previously known as Juvenile-onset Diabetes
DMII aka NIDDM - Diabetes mellitus Type II aka Non-Insulin-Dependent Diabetes mellitus, previously known as Adult-onset Diabetes
DT - delirium tremens
DVT - deep vein thrombosis
ED - erectile dysfunction
ESRD on HD - end stage renal disease on hemodialysis
GAD - general anxiety disorder
GERD - gastroesophageal reflux disease
GIB - gastrointestinal bleed
GVHD - graft vs host disease
HIV - human immunodeficiency virus
HLD - hyperlipidemia aka DLD
HPV - human papillovirus
HTN - hypertension
HUS - hemolytic uremic syndrome
IBD - irritable bowel disease
IBS - irritable bowel syndrome
ICH - intracranial hemorrhage
IDDM - see DMI
ITP - idiopathic thrombocytopenic purpura
LEMS - Lambert-Eaton myasthenic syndrome
LGIB - lower gastrointestinal bleed
LUTS - lower urinary tract symptoms
MAC - Mycobacterium avium complex
MDD - major depressive disorder
MM - multiple myeloma
MS - multiple sclerosis
NIDDM - see DMII
NPH - normal pressure hydrocephalus
NSTEMI - non-ST segment elevation myocardial infarction
OA - osteoarthritis
OCD - obsessive compulsive disorder
OHS - obesity hypoventilation syndrome aka Pickwickian Syndrome
OSA (on BiPAP/CPAP) - obstructive sleep apnea (on bilevel positive airway pressure/continuous positive airway pressure machine)
pAF (on AC) - paroxysmal atrial fibrillation (on anticoagulation)
PBC - primary biliary cirrhosis
PE - pulmonary embolism
RA - Rheumatoid arthritis
SARS - severe acute respiratory syndrome
SLE - systemic lupus erythematosis
STEMI - ST-segment elevation myocardial infarction aka ischemic heart attack
STD - sexually transmitted disease
TB - Tuberculosis
TBI - traumatic brain injury
TIA - transient ischemic attack aka stroke symptoms that last <24 hours
TMJ - temporomandibular joint disorder
TTP - thrombotic thrombocytopenic purpura
UC - ulcerative colitis
UGIB - upper gastrointestinal bleed
URI - upper respiratory tract infection
UTI - urinary tract infection
VSD - ventricular septal defect

subversivegrrl  asked:

Considering two possible injuries to result in unexpected death: through and through small caliber gsw to the upper arm that causes a (venous?) clot that later migrates to the heart, OR bullet fragment under the arm, hits something vital, entry wound overlooked in a hasty evacuation, slow internal bleed, dead in the morning. No immediate medical care available. Is 1st one possible? Would 2nd necessarily produce much external bleeding as well?

Hey there! Let’s dive right in.

The first one is theoretically possible but would take a few days. A clot like that needs time to build up. It’s essentially a deep vein thrombosis (DVT), that breaks off.

It wouldn’t affect the heart though… it would affect the lungs. It would break off, go through the heart just fine, but get caught in the pulmonary vasculature. If it’s big enough, it can cause deathyness.

But Number 2 is your better option. You could even have an entry-no-exit against the underside of the arm, and the character’s chest “feels funny” on that side, and we discover that the bullet slid along the humerus into the chest and caused a pneumothorax on that side. Maybe twenty minutes later they’re gasping and a half hour after that they’re dead from a tension pneumothorax?

Can I suggest a number 3 as well? Bullet strikes brachial artery, big messy bleedy-outy. Or maybe it’s a nick, a slow arterial bleed, so the wound looks okay-ish, gets wrapped with big dressings, and then the character basically bleeds to death inside the dressings?

Just thoughts!

xoxo, Aunt Scripty

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When survivors feel guilty

A little over a year ago, I was diagnosed with a heart condition that required me to go on multiple medications, including anticoagulants. A few months later, I was walking through a moderately busy street in broad daylight when someone came up behind me and, I won’t give the details, but he assaulted me, and I was left with a fairly severe concussion that required several days of hospitalization. I was told not to take anticoagulants due to the risk of a brain hemorrhage. I was also unable to participate in figure skating competitions and other physical activities due to the risk of a second concussion. This was a pretty miserable time. The guy was caught since it was broad daylight, and plead guilty, so fortunately, I didn’t have to go to court, but it still really sucked.

When I was off anticoagulants for about 4 weeks but also barely performing any kind of physical activity, I ended up getting a type of blood clot called a deep vein thrombosis, which lead to a pulmonary embolism. I was hospitalized for two weeks, and had to have surgery to remove the clot, as well as extra monitoring due to the concussion. When everything was done, even with the student health insurance I had, I still had a medical bill of over $40000, and more coming in since I was sick originally.

I was a student. I was broke. My parents didn’t have money, and didn’t even know I was sick or about the concussion. I had absolutely no other way to pay for this. I talked to student legal services at my school, who advised me to file a civil suit against my attacker. Since he had already plead guilty to the assault, there was pretty much no way I would lose. I didn’t really want to. I knew he was a drug addict and was high while the assault occurred. I also knew he was living with his parents without a job, and that his parents were relatively low income. The only asset they had was their house, and it was of relatively low value for the area. I couldn’t imagine forcing an entire family into homelessness. But the months went by. My loans became even greater, most of them due to a much slower recovery from all the events that had happened. I really had no other choice. 

The student lawyer talked to the guy’s attorney, and he agreed to settle. It would have been likely that I would have been able to get much more if I had gone to court, but I took the option they gave me, which was pretty much the entire value of the house, which was just enough to cover my medical expenses, and a little extra in case something happened. I really didn’t want to hurt an entire family, but I also had no other way of getting medical treatment, especially since my insurance was about to expire, since I was graduating soon. 

I think he’s still in jail, and I have no idea what happened to his family, but I still feel incredibly guilty about this. I know this wasn’t my fault. I know that I needed to do what was best for myself after being hurt. I know that I shouldn’t feel guilty about this. I know that my doing what I needed to recover was most important, and that his family’s poverty isn’t my fault, but rather, a fault of the system we live in. I know that filing a civil suit against a drug addict doesn’t make me someone who contributes to legal abuse of drug addicts. But I still felt guilty. And sometimes I still do. But it wasn’t my fault. And it isn’t other survivors’ faults. Whatever happens to your perpetrator. Is. Not. Your. Fault. You were wronged, and the consequences they face aren’t a reflection of you or your character. You need to take care of yourself before worrying about what happens to the person who hurt you. If something happens to them, it’s their own fault, not yours. It’s ok to feel guilty, and it’s often hard not to. But don’t let it get in the way of doing what you need to survive. Take care of yourself, and remember that they are the one(s) that did the wrong thing, not you. 

perthshire-and-pemberley  asked:

If you're interested in FS prompts, here's one: Fitzsimmons start to bond with May over their dislike of coffee (early s1-ish?) because I love May+Fitzsimmons! (Just out of curiosity, would that brotp be called Fitzsimmay, or is there a name already in existence?)

AN ~ Ha! This prompt cracked me up!! and I miss the S1 Bus Fam so much </3 but this was fun!! (as for the name - I think there’s a sort of Mamma May, May & the kids, May & the ducklings thing going but nothing in particular for May+FitzSimmons I don’t think).

Also, inspired by @the-nerdy-stjarna challenging herself to write some beautiful prose recently I decided to challenge myself on some dialogue and banter (which is ofc extra tricky when May’s involved!) Hope you like it :D

Read on AO3

-

Jemma laughed, as Fitz reshuffled his lanky legs in the tight space the backseat allowed them, for the third time.

“Are you quite alright there?” she asked.

“Fine!” he insisted, grumpier than usual. “Just… for ‘field work’ there don’t seem to be many ‘fields’ involved, that’s all. ‘f I wanted to be sitting around in stake-outs all day I’d join the ruddy police.”

“Or become a clown,” Skye suggested.

She snorted with laughter as, desperate to get a proper stretch, Fitz stuck one of his legs between the two front seats – in the space over the handbrake and gearbox – and began flexing his ankle enthusiastically.

“Um, Fitz,” Jemma muttered. “I don’t think you should –“

“What?” he challenged. “D’you want me to get deep vein thrombosis? Because that’s what’s happening otherwise.”

“No, of course not,” Jemma insisted. “It’s just –“

It was just that she hadn’t missed May’s stern face in the rear view mirror. She was certain that May was judging her; judging them, for their immaturity. No doubt as the Cavalry, she’d been on some missions that required an extraordinary sense of control over one’s body. Of stillness. Missions where sticking one’s leg across the length of an entire car was not just poor form, but a deadly mistake.

Of course, as usual, what she thought was unclear, but May’s gaze did not flinch from the mirror, though she must have known that they were reading into it. What they were reading into it. She hated them bringing it up, so they stayed silent, but – appropriately chagrined, and with some difficulty – Fitz drew his leg back into the back seat and muttered an apology.

It was at this moment that Coulson appeared from back across the street.

“Target’s getting coffee so I am too. Anybody want anything?”

“Americano?” Skye requested.

“Sure?” Coulson checked. “Shield’s buying.”

Skye shrugged. “I said what I said.”

Coulson nodded, and pointed his finger to commit the order to memory.

“One Americano,” he recited, and moved his finger to Jemma. “Anything for you?”

“Um, do they have tea? I don’t mind which kind, just, preferably brewed, not bagged.”

Coulson grimaced, unconvinced.

“I’ll see what I can do,” he promised. “Otherwise I hear they do a great wheatgrass?”

“Okay.”

“And you, Fitz?”

“Tea please. Black. Or nothing. Unless we have a better bathroom situation than last time.”

Coulson shook his head, sympathetic.

“Okay. One Americano, one tea-or-wheatgrass, one tea-or-nothing…. and Melinda, might I interest you in the holiday special, mint spice frappuccino with pieces of candy cane?”

He took one look at May’s glare and grinned.

“And one ‘go to hell,’” he finished. “Got it.”

He disappeared to fetch the coffee, and if Jemma was not mistaken, May snorted.

“Well,” May said. “That’s one sensible decision you two have made today.”

“The tea?” Jemma checked. “Oh, no, we don’t care for coffee at all really. You can take the Brit out of Britain I suppose….”

Skye snorted.

“Sure.” She elbowed Fitz. “I saw this one salivating over Coulson’s last offer. He’d sell his soul to coffee for a little good ol’ fashioned whipped cream.”

Fitz scoffed.

“I’ll have you know that’s hardly a coffee,” he retorted indignantly. “It’s practically cream with a little flavour! And you can get it with icecream.”

“Fitz!” Jemma gasped. “You’ve had that thing? Inside your body?”

“Yeah he has.” Skye made a suggestive expression, and Fitz kicked her as best he could from the given angle. All the while, Jemma was beginning an educative rant about the calories, the sugar and fat and Fitz’s diet more generally, and Skye didn’t pause the burgeoning skirmish to cry:

“Don’t bring Little Debbie into this!”

They squabbled even as Coulson climbed into the car a few minutes later, tray of coffees in hand. Unfazed by the ruckus in the back seat, he and May watched the target cross the street in front of them, Ward on his tail, and Coulson passed the tray of drinks over.

“How’s it going?” he asked calmly. “Did you tell them the espresso machine story?”

“I don’t tell stories.”

“To bad, I do. Hey, guys!”

Coulson leaned his head over the back seat. Immediately, the younger three stopped fighting and sat to attention.

“Yes!” Skye cheered. “Hit me with the caffeine, AC!”

“You’re gonna have to fight May for it,” he deflected.

“Keep your damn legs still for the next five minutes and I’ll hand it over,” May promised. After a chorus of ‘yes ma’am’s she begrudgingly handed out the drinks – teas first, and then Skye’s coffee only after Coulson had announced that they needed to move the stakeout van after all.

“Oh yeah,” Fitz remarked with a snort. “Ward’s still out there tailing. Poor sod.”

“Get better at keeping to your damn self and you could be out there too, you know,” May remarked. Startled, Fitz and Simmons shared a glance. May could see Coulson was just about busting a vein trying not to grin at her – he’d always known she’d get attached – but she decided to lean into it anyway.

“I’m just saying,” she clarified. “You have the makings of good agents, all of you. Some of you even have good taste.”

(Skye laughed and raised her Americano in salute to herself. “Burn.”)

“And I think if you knuckled down and put the work in you really could make it into the… ‘actual field,’ one day.”

Fitz shook his head profusely.

“Oh, no thank you. I’ll take a little thrombosis over a bullet to the head any day.”

The van drove over a bump, sloshing his tea, and Fitz cursed.

“Oh, Fitz,” Jemma sighed, and passed her cup to him as she began to search for a piece of tissue or fabric to soak up the spill.

May rolled her eyes and turned her attention back to the road ahead. They had a long way to go.

actual dad to his employees burnie burns

  • basically called everyone he knew to make sure barbara was okay after she sent him a picture of herself covered in (fake) blood
  • brought dinner to ray when ray was alone on christmas
  • went to geoff’s house at four in the morning to get some shotgun shells he left because he was afraid millie would get ahold of them and hurt herself
  • called jack at 2 am to be sure he wasn’t suffering any ill effects from deep vein thrombosis because jack lived alone at the time
  • texted gavin to comfort him when gavin moved out of the house he grew up in
  • was VERY worried when gavin told the story of how he once got drunk and lost his keys and spent a night in a shed in the rain rather than wake anyone up, and told gavin to call him if anything like that happened again

yaoiphobicc  asked:

You're probably getting a lot of stories like this BUT just to reiterate your point here: I went to the ER last year with a possible deep vein thrombosis and I was showing symptoms of an incoming stroke and it still took me four hours to be seen and even when I was finally admitted, they basically shut me away alone in a room and left me alone for hours at a time. I could have had a stroke and nobody would have known or cared. Also, there was a woman in the waiting room with me screaming (1/2)

D-dimer

This is a lab test that assesses for blood clots - which could cause stroke, pulmonary embolism (PE), and deep vein thrombosis (DVT).

D-dimer may be ordered if some of the following symptoms are present upon admission:

  • Swelling, warmth, pain in a leg
  • Chest pain, trouble breathing, tachycardia

A negative D-dimer is typically considered  < 0.50 mcg/mL, although this may vary from hospital to hospital (as with all lab values).

An abnormal D-dimer will help with diagnoses and treatment. Patients with elevated D-dimer’s will likely be placed on a type of heparin, in hopes of preventing additional clots.

My Uworld notes- 6
  • serum sickness is a type 3 HSR characterized by deposition of circulation complement fixing immune complexes and resulting vasculitis. Associated findings include fever, urticaria, arthralgias, glomerulonephritis, lymphadenopathy and a low serum c3 level 5-10 days after intravascular exposure to antigen. type 3 HSR typically activate complement at local site where immune complexes containing IgG and or IgM complement fixing antibodies have been deposited. This often results in hypocomplementemia including decreased C3 level

  • liver dz-a/w AFP

  • carcinoembryonic antigen (CEA) a/w colorectal cancer

  • CA125 -ovarian cancer. Both CEA and ca125 are fr monitoring purposes

  • PSA prostate specific antigen is most useful in establishing extent of prostate cancer and evaluating response to prostate cancer tx.

  • Iced water think cold – cold think cold agglutinins – cold agglutinin associated with infection with mycoplasma pneumonia

  • another cold agglutinin is EBV

  • free air in peritoneal cavity= bowel perforation

  • pancreatic calcification= chronic pancreatitis

  • heavily calcified vessels = atherosclerosis and vascular dz

  • distended bladder= urinary retention

  • air in billiary tract a/w gallstone ileus

  • fluoxetine a/w anorgasmia and decreased libido and increase latency to orgasm. They can however be used to tx premature ejaculation

  • phenelzine= MAO-I used in tx of depression monoamine oxidase is a mitochondrial enzyme that deaminates primary and secondary aromatic amines

  • tricyclic antidepressants can cause orthostatic hypotension example imipramine

  • trazadone- priapism

  • paroxysmal breathlessness and wheezing in young patient unrelated to ingestion of aspirin, pulmonary infection inhaled irritant stress and or exercise should raise a strong suspicion for extrinsic allergic asthma. The granule containing cells in sputum are most likely eosinophils and the crystalloid bodies are most likely Charcot Leyden crystals (contain eosinophil membrane protein)

  • chronic eosinophilic bronchitis in asthmatics involves bronchial wall infiltration by numerous activated eosinophils largely in response to IL5 released by TH2 cells

  • digestion and absorption of nutrients primarily occurs in small intestine. SI cells produce enzymes responsible for nutrient absorption. Proteins in ingested food exist primarily as polypeptides and require hydrolysis to dipeptides tripeptides and amino acid for absorption. Hydrolysis of these polypeptides is accomplished by proteolytic enzymes such as pepsin and trypsin

  • these enzymes are secreted inactive proenzymes trypsinogen and pepsinogen from stomach and pancreas

  • trypsin activates other proteolytics enzymes including chymotrypsin carboxypeptidase and elastase. Activation of trypsinogen to trypsin is achieved by enteropeptidase (or enterokinase)an enzyme produced in duodenum

  • enteropeptidase deficiency results in defective conversion of trypsinogen to active trypsin

  • lipase secreted from exocrine pancreas is the most important enzyme of digestion of triglycerides. Chronc pancreatitis is a painful condition that causes lipase deficiency. This leads to poor fat absorption and steatorrhea

  • secretin is a peptide hormone secreted by S cells of duodenum un response to low duodenal pH. Secretins timulates secretion of bicarbonate from the pancreas and gall bladder and reduces acid secretion in the stomach by reducing production of gastrin. Neutralizing the acidic pH of food entering the duodenum from the stomachis necessary for proper function of pancreatic enzymes (amylase, lipase)

  • trisomy 18 (47XX: Edwards syndrome

    • face: micrognathia, microstomia, eye defects (microphthalmis, cataracts) low set ears and malformed ears prominent occiput

    • CNS: microcephaly, neural tube defects (meningocele, anencephaly), holoprosencephaly, arnold chiri malformation, severe MR delayed psychomotor development

    • musculoskeletal: clenched hands with overlapping fingers (index finger overrides the middle fingerand fifth finger overrides the fourth finger) rocker bottom feet short sternum and hypertonia

    • cardiac: VSD, PDA

    • distinguishing features: clenched hands and or overlapping finger

    • GI: Meckel diverticulum, malrotation

    • ultrasound: intrauterine growth restriction and polyhydramnios especially ina fetus with abnormal hand arrangement

  • unlike patients with Edward’s syndrome neonates with Patau syndrome (trisomy 13) have cleft lip and palate, polydactyly and omphalocele. Patau syndrome is not a/w low set ears and overlapping fingers but do present with rocker bottom feet also

  • 47XXX karyotype is clinically silent however, some affected women have slightly decreased IQ scores. Female newborns with this karyotype are phenotypically normal with no obvious dysmorphism

  • 47XXY Kleinfelter’s syndrome: may be a/w mild mental retardation or normal intelligence. The typical patient is tall mall adult with gynecomastia small testes and infertility. Male newborns with this karyotype are phenotypically normal with no obvious dysmorphism. The clinical findings do not become apparent until adulthood.

  • Sudden onset of abdominal or flank pain hematuria and left sided varicocele together suggests renal vein thrombosis a well known complication of nephrotic syndrome. Nephrotic syndrome is a hypercoagulable state d/t increased loss of anticoagulant factors especially anti thrombinIII (responsible for the thrombotic and thromboembolic complications of nephrotic syndrome)

  • venous drainage from left testes travels throught the left testicular vein into the left renal vein and from there the IVC. In contrast to the right testicular vein which empties directly into the IVC. This difference in venous drinage gives diagnostic significance to left sided varicocele in that it often indicates an occlusion of the left renal vein by a malignant tumour or thrombus

  • malaise low grade fever followed by a facial rash. Feels better now but still has the rash- red flushed cheeks with – clinical presentation of erythema infectiosum aka fifth dz. As the facial rash fades an erythematous rash in reticular lace like pattern often appears on trunk and extremities. The rash of erythema infectiosum is thought to result at lest partly from local immune complex deposition once serum levels of virus specific IgM and IgG have attained high enough levels.

  • Erythema infectiosum= non enveloped DNA virus called parvo B19. The blood group P antigen globoside is a parvovirus B19 is highly tropic for erythrocyte precursors particularly erythrocytes and erythroid progenitor cells

  • Parvo B19 replicates predominantly in the bone marrow

  • anthracyclines daunorubicin doxorubicin epirubicin and idarubicin are chemotherapeutic agents a/w severe cardiotoxicity because of their unique ability to generate free radicals.. Dilated cardiomyopathy is dose dependent and may present months after discontinuation of the drug . Swelling of sarcoplasmic reticulum is the morphologic sign of early stage doxorubicin associated cardiomyopathy. Followed by loss of cardiomyocytes and its symptoms are those of biventricular CHF including dyspnea on exertion orthopnea and peripheral edema

  • dexrazoxane prevents Doxorubicin associated cardiomyopathy because dex is a iron chelating agent that decreases formation of free radicals by anthracyclines.

  • Restrictive cardiomyopathy a/w hemochromatosis amyloidosis sarcoidosis and radiation theraapy : remember -osis

  • hypertrophic cardiomyopathy caused by mutation of beta myosin heavy chain

  • focal cardiomyopathyscarring commonly results in MI

  • pericardial fibrosis usually follows cardiac surgery radiation therapy or viral infections of the pericardium

  • PCP aka angel dust aka phencyclidine commonly associated with violent behaviour

  • LSD can also cause aggressive behaviour but it is more typically characterized by affective liability thought disruption )delusion) and visual hallucination whereas PCP produces more psychomotor agitation including clonic jerking of extremities

  • angel dust can be put on marijuana and smoked LD is ingested orally

  • secobarbital is a street barbiturate a CNS depressant which leads to drowsy drunken state of consciousness without the violent behaviour

  • heroin (opioid) produces CNS psychomotor depression and respiratory depression miosis and bradycardia are common

  • dry tap with no splenomegaly or lymphadenopathy – think aplastic anemia which causes pancytopenia

  • aplastic anemia= hypo cellular bone marrow with fat cells and fibrotic stroma

  • hyper cellular marrow with increased blasts found in myeloproliferative d/o and certain leukemias

  • most common side effect of streptokinase= hemorrhage . Streptokinase is a thrombolytic agent that acts by converting plasminogen to plasmin which subsequently degrades fibrin. It is a foreign protein derived from streptococci and induce HSR.

  • Dissection of ascending aorta manifests as tearing chest pain that radiates to the inter-scapular area commonly occurs in hypertension marfans and ehlers danlos

  • hyperactive jaw jerk reflex when lightly tapped= chvostek’s sign- Hypocalcemic – facial m contraction elicited by tapping facial nerve just anterior to ear. The most common cause of outpatient hypocalcemia is primary hypoparathyroidism which is often d/t prior loss of parathyroid tissue during thyroidectomy

  • scotoma is visual defect that occurs d/t pathologic processes that involve parts of retina or optic nerve resulting in discrete area of altered vision surrounded by zones of normal vision. Lesions of macula cause central scotomas.. examples would include MS, diabetic retinopathy and retinitis pigmentosa

  • verapamil is a calcium channel blocker that slows SA and AV node phase 0 depolarization (in nodal cells, the phase of depolarization is mediated by calcium influx)

  • phase 0 depolarization of cardiac conduction system occurs during diastole thus verapamil slows diastolic depolarization

A Cautionary Tale

When patients are laid for days in post-op care they are at higher risk for a deep vein thrombosis (DVT). This is when blood pools in your extremity that isn’t being used much and causes a clot to form. This can have multiple implications that are bad; Pulmonary embolism, stroke, or block the venues line causing fluid back up distal to the blockage.

With that being said, we like to have patients up and moving around as soon as possible. It might not be much, just sitting in the chair for meals or going to the bathroom, but any movement is good movement. It’s standard protocol for medical staff and it is always go to help with a speedy recovery.

My Cautionary Tale

There once was a patient that was too lazy. She didn’t like to get up to use the bedside commode or sit in the chair. All of the aides and all of the nurses spent hours trying to convince her. She would go begrudgingly and usually when we needed to force her to, so we could changer after she purposefully soiled herself.

When they put her on to hourly commode breaks, she wasn’t happy and would refuse regularly and complain when she wet herself again. Her passive aggressive attitude towards staff was bad and no one wanted to deal with her. This continued for three weeks and since she refused move, physical therapy couldn’t get a decent evaluation, causing her to be delayed. Then she would refuse to leave, since she was receiving timed narcotics too.

Finally, she left to head home to her nursing home, since she’s not able to take care of herself. Unfortunately, nursing homes do not always take the best care of patients, let alone have them get up to move around. So, for a week and a half, she laid in bed. But then she was back.

She ended up passing a DVT to become a blockage in her brain, causing her to have a stroke. After her stroke came a series of little seizures and she fell from her bed falling and breaking a bone. That is when she returned to use.

Though she was a bane to all that deal with her, it is still terrible to have something so preventable from happing. Had the patient been willing to move, she might have not had this issue. For all the nurses, students, and aides out there, remember that we may not like to deal with these patients, but it just might mean their health or their life.

Why Wayfaring Doesn't Treat Family, pt 1.

**From the Archives of My Brain, An Adventure of Wayfaring Med Student**

Stepdad: Hey look at my leg. It really hurts and it’s kind of red and swollen. 

Wayfaring Med Student: Don’t ask me for medical advice. I’m not a doctor yet. Plus you never listen to me anyway. Go to your doctor.

Stepdad: You’re so selfish. You don’t care about people at all. You need to work on your compassion for other people. Just look at my leg!

Wayfaring Med Student: *takes a quick look and finds a red, warm, swollen lower leg that is very tender to the touch* Ok, now I’m going to say it again. You REALLY need to go see your doctor. Like right now.

Stepdad: Why? What is it?

Wayfaring Med Student: You either have cellulitis, which could get bad quick considering your diabetes, or you have a blood clot in your leg. Either way, you need to be seen immediately. 

Stepdad: Nah, it’s not that bad. I’ll wait till next week.

Wayfaring Med Student: Ok. I’m just saying that if it gets worse, I told you so. Enjoy your pulmonary embolism or your gangrene. 

Stepdad: You don’t know anyway. You’re not a doctor yet. 

*Several days pass. Wayfaring goes back to medical school.*

Mom on phone: So he finally went to the doctor. He had an ultrasound of his leg and he definitely has a blood clot. They started him on blood thinners. 

Wayfaring Med Student: I FREAKING TOLD HIM! That idiot. He better never ever ask me another medical question again. 

anonymous asked:

Hey! Not a consultation request, but a clarification one! I've noticed you (and sometimes the people asking the questions as well) use a lot of acronyms, and for a non-native speaker these can be super confusing, especially since googling often doesn't help at all (for example, a recent question mentioned DV and google suggested digital video for that...). So what I'm asking, if it's not too much trouble, could you add the explanations for those? Love your blog!

Hey! I’m so sorry! I’ll try to be more conscious of acronym usage in the future. Medical jargon is chock-full of acronyms, like getting ROSC after CPR on your 80YOF with a Hx of a DVT and a suspected PE, which makes absolute sense to an insider but must be absolute hell on outsiders.

[For those of you who didn’t instantly unfollow me based on that last sentence alone, it translates as “getting Return of Spontaneous Circulation (ie getting pulses back) after cardiopulmonary resuscitation (chest compressions) on your 80 year old female (patient) with a history of Deep Vein Thrombosis (a blood clot in a big vein, typically in the leg) and a suspected pulmonary embolism (blood clot that’s moved to the lung)].

I will try to be better about spelling things out and being clearer with language moving forward, anon. Sorry that I’ve been confusiony up til now!

xoxo, Aunt Scripty

Heavensward Prep IRL: The Checklist

Credit for this post is on Reddit here and since HW is coming up, I think this is important to keep in mind to get the IRL stuff out of the way/taken care of before we succumb our souls to the Early Access and the Expansion

1) Enough hard drive space to install Heavensward?

2) Responsibilities. RL comes first. Make sure your spouse/kids/housework are taken care of before you sit down. Those who still live at home, make sure your room is clean, the dishes are done, and you’ve done all the stuff you’ve been nagged to do: trust me, it’s better than being dragged away in the middle of a cutscene to take the trash out.

3) Hydration. You’re undoubtedly going to be sitting at your computer screen for hours (days?) on end, and dehydration leads to headaches which makes playing NOT FUN. :( Have a big old jug of water and your soda of choice sitting there ready to go.

4) Nourishment. You’re gonna want snacks and eventually, proper food. Prep your meals in advance so that all you have to do is zap them in the microwave or chuck them in the oven. (Rice, chili, pasta, curry, and pizza all reheat awesomely.) Make sure you have an ample supply of your favorite snacks! (Personally crock pot foods are also good and they can last a while!)

5) Comfort. Get your blankets/pajamas/heater/air conditioner/slippers/fan ready to go. You don’t need to wear pants. Pants are for losers.

6) Gear. Make sure your headset and your mouse & keyboard/gamepad is A+ and ready to go.

7) Read the patch notes, or at least skim them. Do this while the game is installing/downloading.

8) TAKE BREAKS. I’m not your mother, but really, you’ll feel better if you take the occasional ten minutes to go stare at the stars/sun (not recommended) and pet your dog. GETTING UP, STRETCHING AND WALKING IS SUPER IMPORTANT last thing anyone wants to get are pinched nerves or Deep Vein Thrombosis your body is important 

See you in Eorzea!